February 14, 2014

What is killing young Central American men?

Over the last decade drug trafficking and violence have taken the lives of thousands of people, most of them young men, in Guatemala, Honduras, and elsewhere in Central America. Far less known is Central America’s hidden killer disease that has recently been named Mesoamerican nephropathy.

Mesoamerican nephropathy appears to be an emerging form of chronic kidney disease of unknown etiology that disproportionately strikes young male agricultural workers primarily in the Pacific coastal regions of El Salvador and Nicaragua, but also in Guatemala and Costa Rica.

According to Correa-Rotter et al the syndrome was first described in 2002 as a form of advanced chronic kidney disease at the Rosales Hospital, a referral hospital in the capital of El Salvador, which developed without the usual chronic risk factors such as diabetes and hypertension. Among its most common features, Mesoamerican nephropathy typically presents as a progressive tubulointerstitial form of renal disease and failure with no or low grade proteinuria.

The histopathology findings from renal biopsies are unique and different from other causes of renal disease. It most commonly affects young men working in sugarcane plantations along the lowland Pacific Coast of Central America. Because this part of Central America is a resource poor area, those affected often die prematurely due to inadequate access to renal dialysis.

Some investigators believe that Mesoamerican nephropathy is now the leading killer of young male sugarcane workers in Nicaragua and possibly El Salvador.

A number of theories have been advanced to explain the etiology of Mesoamerican nephropathy. They include environmental exposures to various agrochemicals, heavy metals, and mycotoxins, as well as recurrent dehydration in the setting of Central America’s hot coastal climate.

We are proponents of exploring potential infectious causes, especially zoonotic neglected tropical diseases from rodents that notoriously infest sugar cane plantations. Lead candidate infections might include leptospirosis, hantavirus, and Mansonella filarial infections, which are well known in Central and South America.

Still another possibility is West Nile virus infection shown recently by one of us (KOM) and her colleagues to produce a chronic and progressive renal disease leading to kidney failure.

WNV infection may now represent a leading cause of renal disease in Texas, and it is conceivable that this mosquito-transmitted disease may have emerged on Central America’s Pacific Coast.

Comments

Over the last decade drug trafficking and violence have taken the lives of thousands of people, most of them young men, in Guatemala, Honduras, and elsewhere in Central America. Far less known is Central America’s hidden killer disease that has recently been named Mesoamerican nephropathy.

Mesoamerican nephropathy appears to be an emerging form of chronic kidney disease of unknown etiology that disproportionately strikes young male agricultural workers primarily in the Pacific coastal regions of El Salvador and Nicaragua, but also in Guatemala and Costa Rica.

According to Correa-Rotter et al the syndrome was first described in 2002 as a form of advanced chronic kidney disease at the Rosales Hospital, a referral hospital in the capital of El Salvador, which developed without the usual chronic risk factors such as diabetes and hypertension. Among its most common features, Mesoamerican nephropathy typically presents as a progressive tubulointerstitial form of renal disease and failure with no or low grade proteinuria.

The histopathology findings from renal biopsies are unique and different from other causes of renal disease. It most commonly affects young men working in sugarcane plantations along the lowland Pacific Coast of Central America. Because this part of Central America is a resource poor area, those affected often die prematurely due to inadequate access to renal dialysis.

Some investigators believe that Mesoamerican nephropathy is now the leading killer of young male sugarcane workers in Nicaragua and possibly El Salvador.

A number of theories have been advanced to explain the etiology of Mesoamerican nephropathy. They include environmental exposures to various agrochemicals, heavy metals, and mycotoxins, as well as recurrent dehydration in the setting of Central America’s hot coastal climate.

We are proponents of exploring potential infectious causes, especially zoonotic neglected tropical diseases from rodents that notoriously infest sugar cane plantations. Lead candidate infections might include leptospirosis, hantavirus, and Mansonella filarial infections, which are well known in Central and South America.

Still another possibility is West Nile virus infection shown recently by one of us (KOM) and her colleagues to produce a chronic and progressive renal disease leading to kidney failure.

WNV infection may now represent a leading cause of renal disease in Texas, and it is conceivable that this mosquito-transmitted disease may have emerged on Central America’s Pacific Coast.